Daycare Nightmares

In response to growing demand, the number of daycare facilities in Missouri is increasing each year. So are the problems.

Corinne Patton, coordinator of the public-awareness campaign for the Missouri Child Care Resource and Referral Network: "There is a lot going on in child care right now; we are getting more attention than ever before. Some of that close scrutiny is going to point out what is not OK."

At a KinderCare daycare facility in Florissant on a cold January morning in 1999, a driver accidentally left three children in the van outside. The two 6-year-olds and a 7-year-old waited in their seats, frightened and worried -- honking the horn, crying out for help, fretting over such things as whether turning knobs on the dashboard might cause the van to explode. Eighty minutes passed before the driver realized what she had done and brought the children inside.

At the Children's Corner in Webster Groves, the home's operator used an unfinished piece of plywood to confine a troublesome 3-year-old inside a playpen during naptime -- using clamps and ropes to hold the board in place.

At the La Petite Academy in Bridgeton, a worker gave unauthorized medication to an infant who was "bawling his head off." Another worker there waited four-and-a-half hours after a 3-year-old fell from a slide on the playground before calling the boy's mother. When the woman took her son to the emergency room, she learned he had a broken elbow.

Violations documented in dozens of state files on daycare centers and homes in the St. Louis area run the gamut from workers' biting or smacking children to forcing preschoolers to clean up an overflowing toilet or stand alone inside a darkened, closed bathroom. There have been cases in which up to 24 children have been left with a single caregiver, cases in which facilities have been infested with cockroaches or mice. One child was left behind after a field trip to the St. Louis Zoo; another was left behind at a skating rink. A 6-year-old climbed atop a daycare-center roof, unnoticed until a neighbor called. A 10-month-old infant at one center was picked up by a woman who said she was a family friend; no one asked her for formal identification. At another, three young girls accused their male child-care worker of molesting them.

Last year, the Missouri Department of Health's Bureau of Child Care Safety and Licensure saw a whopping 36 percent increase in complaints against child-care centers and family child-care homes statewide -- to 1,900, up from 1,400 a year earlier. The state estimates that at least a third of the allegations were substantiated. In the St. Louis area alone, it substantiated more than 100, including those at the KinderCare in Florissant, Children's Corner in Webster Groves and La Petite in Bridgeton.

And yet not one facility in the St. Louis area had its license suspended or revoked. Not one paid a fine. And not one was required to inform the parents of other children enrolled there about the violations that had occurred. All of the providers cited in the substantiated cases in the St. Louis area continue to operate, with some caring for more than 100 children every day.

In Missouri, only the most egregious violations end with denial or revocation a facility's license. Last year, that happened only seven times, and in one case, it took a baby's death to close down the home.

So far in 2000, the number of complaints has risen by 20 percent. Margaret Franklin, who heads the Missouri Bureau of Child Care Safety and Licensure, attributes the increasing numbers to growing parental awareness of a troubling daycare reality. "The level of quality is not where it should be," she says. "A lot of the child care is good, but the majority is poor to inadequate."

And the state is often reluctant to come down too hard -- because demand for child care already exceeds the supply.

In the past decade, the demand for child care has exploded as more families have come to rely on two paychecks and as government has pushed parents on welfare into the workforce. In Missouri, the number of licensed daycare facilities shot up from 2,592, with the capacity to serve 71,000 children, in 1989 to 4,033, with the capacity to serve 124,000 children, in 1999, a 75 percent increase in serving capacity.

Inspecting and monitoring those facilities is another matter. The number of child-care inspectors has gone up over the last decade, particularly since 1996, but it did not keep pace with the growth until the Bureau of Child Care Safety and Licensure received funding for 17 new positions last year, for a total administrative staff of 126, not all of whom are inspectors. The average caseload, currently about 75, is expected to decline to around 68 or 70 as the new positions are filled. But that is still much higher than the 1-to-50 ratio recommended by the National Association for the Education of Young Children. Missouri inspectors visit facilities at least twice a year -- with at least one visit unannounced -- and each licensed facility is also inspected by a sanitation inspector and a fire marshal. But that's only for the licensed facilities. Most daycare facilities in Missouri are not. Anyone who takes care of fewer than five unrelated children needs no license, for example. Also exempt from most licensing regulations are nursery schools, half-day programs, summer camps and child care run by religious organizations. Working Mother magazine rates the states for child care each year, and Missouri has yet to make the top 10. Instead, the magazine characterizes Missouri as "rather undistinguished ... with some of the worst rules in the nation for the oversight of family child care."

Even for facilities that are licensed and inspected, breaking the rules usually means little more than a slap on the wrist. Inspectors are likely to give violators a second chance and, in some cases, a third, fourth, fifth or sixth chance. The most common penalty for a serious violation, such as forgetting a child on a field trip, involves a "facility review conference," in which the child-care provider meets with state officials, signs off on a perfunctory corrective-action plan and agrees to follow the rules, train employees or develop a plan to prevent a recurrence of the problem.

At the KinderCare on Cross Keys Drive in Florissant, where children were left in a van for 80 minutes, an inspector concluded that four state regulations had been broken. The driver was fired; the area manager contacted the parents of the children involved, and other van drivers were "advised to follow KinderCare policies regarding transportation of children." The state concluded that those actions "resolve the issue."

At the Children's Corner in Webster Groves, where the 3-year-old was imprisoned with plywood over a playpen, the owner was told to consult with the state before implementing any "unusual" techniques. She was asked to develop a "special needs" plan for children with special needs. The state agreed to make extra visits over a 90-day period. The facility kept its license, and in April, the state allowed Children's Corner to increase the number of children the center cared for, from eight to 10, provided the owner hired another caregiver.

At the La Petite Academy on De Paul Drive in Bridgeton, which was the subject of a series of substantiated complaints, the state held a facility-review conference in May 1998 after repeated instances in which the center violated staff-to-children ratios. La Petite agreed to abide by the ratios and log the number of children and staff present every 15 minutes for a two-week period while undergoing unannounced inspections. In March 1999, a worker gave an infant unauthorized medication for gas because he was "bawling his head off." That worker was fired. Two months later, a worker was seen pulling 2-year-olds from a fence and throwing them to the ground. Four months after that, in September, a 3- year-old fell off a slide, but his mother wasn't called until four-and-a-half hours later -- during which time the boy's elbow swelled. At the emergency room that evening, the mother learned that her son had a broken elbow. The state's response was to require a staff meeting explaining "parental notification" rules when a child is injured and have employees sign a form agreeing to abide by the rules.

Franklin, the state's bureau chief of child care, says inspectors repeatedly try to work with a facility to correct its problems. "We try to be very fair and very consistent," she says. "We hate for children to be left behind on field trips. When they fire that employee who is responsible, do we close that center and put 60 families out without care? If they have taken action to prevent it from happening again, and they talk to the person and fire them, in many instances, hopefully it won't repeat itself. Each case is so unique."

Sometimes the problems repeat themselves anyway. A lack of supervision was repeatedly found at the Tendercare Learning Center in Florissant in 1998 and 1999. At one point, as many as 14 3- and 4- year-olds were taken on a field trip with a single staff person, violating state-mandated ratios. A 6-year-old climbed atop the facility's roof, unnoticed by staff; a neighbor called to alert them. A 7-year-old walked home from the center unnoticed. And a 9-year-old was sent out to clean a daycare van in the parking lot, unsupervised. At a facility-review conference in December, Tendercare agreed not to let children leave the building unsupervised or leave them unattended and to train staff on those procedures.

Only the most alarming violations carry any risk of closure. Franklin says the most severe sanctions -- suspension or revocation of licensure -- are generally reserved for facilities where "something drastic happened to a child" or the violations "continue and continue and continue."

Of more than 4,000 licensed facilities statewide, and hundreds where violations were substantiated, just two dozen were subjected to the state's most serious sanctions in 1999 -- fewer than 1 percent. Fifteen signed a "settlement agreement," two had their initial licenses denied, three had their license renewals denied and four licenses were revoked. Another seven were referred to prosecutors for providing child care without a license.

Those whose licenses were revoked included Mary Marleen Beard of Lake Ozark, who is charged with second-degree murder in the alleged shaking death of Elijah Steen, who died last October of brain injuries while at Beard's family child-care home. Lisa Butler of Kansas City, a family child-care home provider, had her license revoked in November after she was caught -- seven times -- allowing animals to roam freely in the children's outdoor play area, including a goat, two dogs and two cats. She had been forbidden from doing so in May 1998 after one of her dogs bit a 17-month-old child in the face, requiring six stitches. The state also revoked the license of Christine Lawson, who ran a St. Joseph home with a long list of unresolved safety problems, after a 2-year-old wandered off unnoticed in October 1998. He was found a half-mile away.

The parents of other kids at these facilities, let alone the public, don't learn about these problems easily, because daycare providers are not required to inform parents of the results of state inspections -- only to post their state licenses in their facilities. Violations can only be found by looking through thick files at the Bureau of Child Care's office at 220 S. Jefferson Ave. Although those files are public, only three to five parents a week, on average, examine them in St. Louis -- suggesting that most are either unaware of the files or do not have the time.

The Child Day Care Association in St. Louis can give parents a list of providers in their ZIP code and a list of questions to ask and things to look for when they visit a facility. For the most part, however, it is up to parents to play private detective dtermine the quality of a facility -- by calling other parents, spending long periods of time observing staff or poring over files to learn whether a facility has a history of problems with the state.

For Internet-savvy parents, there is one other place to go for help. Employees of licensed facilities must undergo a criminal-background check, and the state recently made it easier to research the criminal backgrounds of unlicensed child-care workers through its Caregiver Background Screening Service, which will screen an individual's name through both criminal checks and through the state's child-abuse-and-neglect registry. Parents can log onto an Internet site (gov.state.mo.us/background/). Before 1999, the state did not require such checks of its registered vendors -- individuals who receive state subsidies to provide child care.

The state is also creating a computerized database of licensing records to make it easier for parents to check a facility's record on the Internet. But that database is likely two years away, and the information, particularly that involving substantiated complaints, may not be very detailed. Unsubstantiated complaints, particularly a series of them alleging a similar problem, can often be more telling than a single substantiated complaint, says Pauline Koch, executive director of the National Association of Regulatory Administrators, who previously worked for the state of Delaware in the area of child-care regulation. In Missouri, however, unsubstantiated complaints are not open to the public.

The system of child care in the military, which has improved significantly in the past decade, requires that a parent accompany an inspector on visits, helping enlist parents in ensuring a facility's compliance with the rules. Some states require centers to post any violations on the door. Missouri does not.

That idea has been proposed and is being pursued, say state child-care officials. But with the state's complicated rule-making process, even that is at least a couple of years away.

Weak regulations and inadequate oversight of child-care providers can prove a recipe for disaster. Just look south to Tennessee. That state was widely viewed as one of the weakest in the nation in terms of supervision and quality, with children-to-staff ratios higher than those of most states -- at one staff member per six infants, for instance, compared with a 1-4 ratio in Missouri. Its caseloads for inspectors were far lower than those in Missouri, however, at one to 20, and Tennessee inspectors visited child-care providers at least three times a year, in addition to license-renewal visits.

Tennessee attracted national attention this year as its regulatory system underwent a major overhaul -- but only after two Memphis children died in daycare vans on a single day last summer. Darnecia Slater, 22 months, was forgotten in a child-care van on a hot day and discovered seven hours later. Her core body temperature had soared to 108 degrees. Across town at another center, 2-year-old Brandon Mann was left in a van for more than five hours. He, too, died of hyperthermia.

In the aftermath of the deaths, the state's Department of Human Services adopted a zero-tolerance policy for centers that broke the rules and endangered the lives of children in their care. "Those were the extremes of the extreme," says Lisa Gallon, a Tennessee DHS spokeswoman. "We were having a lot of children being left on vans because they didn't thoroughly check the vans. After those two deaths happened in July, our commissioner got our child-care folks together and said, 'We need to do something to get the attention of providers.'"

The deaths spurred new legislation, giving the agency power to immediately shut down a center if children's life, health or welfare was in jeopardy, or to fine centers as much as $1,000 per day for major violations. The state is also creating a "report card" system to inform parents about the quality of care at individual centers. The number of licensing visits was doubled from three to six annually, and caseloads shrank to 10 or 15 per inspector. In the past year, 15 centers were shut down by the state. Tennessee's progress is being closely watched by child advocates across the country, including Missouri.

In June alone, Tennessee's DHS suspended the licenses of three facilities and closed them immediately. One was a Nashville center that left a 4-year-old behind at a skating rink, the latest in a series of violations at that facility. Another was a center at which a 34-month-old child was assaulted by a teenager who slipped inside unnoticed. And a third was closed after a 3-year-old wandered away from the center.

At the root of the national child-care crisis is money. Regulators, children's advocates and centers themselves agree that providing quality child care costs money -- more money that most parents are able to afford.

Helen Blank, director of child care for the Children's Defense Fund, says problems with child care aren't unique to Missouri. "We don't have the kind of quality that children deserve. You can't blame the child-care providers themselves -- they work long hours with incredibly small salaries. This is an area that just hasn't risen to the top that policy makers see as deserving of the kind of resources you need, which is ironic, since we know a good early start makes a difference in children's ability to enter school ready to succeed. It's not just licensing and quality. It's whether families can afford good care. Child care is not a luxury. The majority of women are working out of economic necessity."

What parents want and what their paychecks will allow are often two different matters, say Franklin, Missouri's bureau chief for child-care regulation.

"Quality costs, and those same parents, whether low- or middle-income, probably can't afford much more," Franklin says. "A lot of our parents are paying as much for child care in a year as I am paying for my child to go to a Missouri (university) for tuition for one year. In the higher-education world, I could, if I wanted, get help to put my kids through college. In child care, someone a little bit above the poverty level can't get any help."

The result is a network of facilities in which the children are in the care of overworked and underpaid employees. Citizens for Missouri's Children notes that the median income for a child-care worker is $13,156 -- and many providers do not offer benefits such as health insurance. The low salaries lead to high levels of turnover. A 1997 study by the Center for the Child Care Workforce found an average turnover rate of 31 percent for child-care teachers and assistants. One-fifth of centers reported losing at least half of their teaching staffs in a single year.

Research is continually demonstrating the importance of quality child care -- and the benchmarks of quality are generally measured by low turnover, low staff-to-child ratios and high levels of teacher training and education.

One four-year study, commissioned by the U.S. Department of Health and Human Services' Maternal and Child Health Bureau, found infants and toddlers in better-quality daycare tested a full 12 points higher on IQ tests than did those in lesser-quality care.

The National Institute of Child Health & Human Development, part of the National Institutes of Health, has been tracking 1,364 children since 1991. Its research, so far, has found that higher quality of care is related to better mother- child relationships, fewer reports of children's problem behaviors, higher cognitive performance, higher language ability and a higher level of school readiness.

Both studies gauged quality in part by the National Health and Safety Performance Standards published by the American Academy of Pediatrics and the American Public Health Association. Those standards recommend a ratio of three children per caregiver for children under 24 months. For children between 31 and 35 months, they recommend a 5-1 ratio. And the standards suggest that all caregivers have knowledge of early-childhood development -- such as an undergraduate degree in early-childhood education, social work, nursing or another child-related field, or a combination of experience under qualified supervision and college coursework, or one year's experience.

Missouri's standards are far less rigorous. The required ratio for infants and toddlers is 4-1; for 2-year-olds, it is 8-1. Directors of child-care centers must have 120 hours of college coursework, including studies in early-childhood education. For child-care workers, there are no education requirements -- they must be at least 18 and must pass background checks.

Workers, once hired, need undergo only 12 hours of annual training.

Denise Mauzy is project director of Opportunities in Professional Education Network, a Missouri initiative that is developing standards for training and a trainer registry. Currently, someone could theoretically offer a class on coloring with crayons and it would qualify, as long as the person offering it could "print out a certificate saying someone had been in your class for two hours," Mauzy says.

T.E.A.C.H, a project begun in North Carolina, is being pilot-tested in the St. Louis area for child-care providers who serve employees of IBM, Citicorp and AT&T, because those companies are members of a business collaborative funding the program. It will pay for 80 percent of a child-care worker's tuition if he or she pursues an associate's degree, as well as other expenses, and the workers' employers have agreed to reward them with bonuses and salary increases as they complete their coursework. But the pilot project is small -- with funds for only 23 scholarships.

Growth through Education Means Success (GEMS), a pilot project under way in Columbia and Macon and funded by the Missouri Department of Health, is examining the effectiveness of 36 hours of classroom training for newly hired workers. GEMS, however, has unwittingly underscored the turnover problem. Of the 40 workers it began with in January, just 13 remain.

"That shows how hard it is to keep the entry-level provider engaged," says Mauzy. "Some of them quit, changed jobs, had family emergencies that required them to find a job that paid more."

Last September, in an effort to improve quality of care, Missouri began paying 20 percent more to subsidized providers who get accredited by a state or national organization. They can also receive another 30 percent if more than half of the children they serve are subsidized children. The state also pays an extra 15 percent for evening and weekend care and another 25 percent for special-needs children.

But so far, of 2,921 subsidized facilities, only 89 -- or 3 percent -- have been accredited.

A parent looking for quality, affordable care can become discouraged.

Corey Burns, who is in the midst of a divorce and has custody of his three children -- ages 2, 3 and 5 -- began looking for child care three months ago. He needs off-hours care because he works at least two nights a week. He's visited a dozen facilities looking for good care that he can afford. No dice. "You go to some of these places, and sometimes the workers are saying, 'I don't know if you want to be here. I don't know if I'm going to be here next week. I don't know if she's going to have anybody.' It makes you kind of leery," says Burns. "If they don't have a staff, they can't operate." He's seen other problems: "The majority of them don't seem to have degreed teachers or a real curriculum set up. It's 'We're here. We can make sure they're alive when you get back,' and that's that.

"I saw providers that were overwhelmed, and I mean the people, the actual staff there," Burns continues. "I don't know what the acceptable ratio is, but maybe you have two providers to 12-14 children, and they're looking haggard and they're looking tired. Along with them being haggard and tired out and that, you see it in the kids. Yeah, you've got your snotty nose here and a diaper that's past over there, but when you see six or 10 kids looking like we could really use another hand around here, it makes you think. You can give them the nicest facility in the world, a nice gated outfit and a backyard with some good toys, but when the people caring for the kids are tired and unappreciated, it definitely has an effect on the kids."

There is the issue of cost. Burns says he believes he can qualify for child-care subsidy from the state, and he will pay as little as $3 a day per child. But if a raise pushes his earnings up to more than $441 a week, gross income -- not much for a man raising three children -- he gets no subsidy at all. At his current salary, he estimates that on his own, without a subsidy, he would pay $75 per child per week, and his take-home pay after that would be just $150 a week.

Subsidized providers, meanwhile, are paid only the median cost of child care in the metro area; prices vary on the basis of location and the child-to-staff ratio of the center. For the care of an infant, for example, the state will pay a provider just $128.75 a week, or about $557 a month. The La Petite Academy in Bridgeton charges $600 a month for an infant, a KinderCare in West County charges $740 a month, and the Martha Rounds Academy for Children in Brentwood charges $928. Centers that provide a lower ratio of children to staff than that required by the state, such as 3-1 for infants and toddlers instead of 4-1, can cost as much as $870-$1,380 a month. Many have long waiting lists, especially for infant care.

In the current climate, state regulation can be the last defense to protect the health and safety of children in child care -- and that line of defense is often weak and inadequate.

William Gormley, a professor of public policy at Georgetown University, is one of the few researchers who has conducted extensive research on regulation and its effect on the quality of child care. In Vermont, he documented how the state's decision to make fewer visits to higher-quality centers to spend more time at problem centers actually led to a decline in quality at those "good" centers. One of the greatest problems today, he says, is weak enforcement when violations are discovered.

"Child-care regulatory enforcement is really the weak link in the child-care chain," Gormley says. "Every state has child-care standards that cover things like child-to-staff ratios, education and training requirements, safety requirements for playgrounds, but they don't mean much unless they are enforced." Most of the time, he says, they are not: "The unfortunate truth is that even demonstrably bad daycare centers are unlikely to be shut down. A child-care licensor has to convince her supervisor this is a very serious matter, has to convince an assistant attorney general this is a very serious matter, has to convince an administrative-law judge or an actual judge that the center should have its license revoked. It's a very protracted legal process in most states."

Gormley says intermediate sanctions -- such as fines and the posting of violations on the front door or in another prominent location -- are critical because the lesser ones, like the warnings or corrective-action plans used in Missouri, are unlikely to have much of an effect and because the more serious ones, like closure, are unlikely to be invoked.

Instead, Missouri relies on a tiered process of corrective-action plans, facility-review conferences and, in more serious cases, formal letters of warning or censure. If those methods fail, the state will pursue "settlement agreements" in which a provider agrees to waive a formal disciplinary-hearing process in exchange for being allowed to continue operating under a series of conditions set by the state. Recent legislation also made it easier for the state to suspend a license if a child is in "imminent harm," requiring the facility to close immediately.

The Greater Dimension Child Care Center in Cape Girardeau signed a settlement agreement with the state in March 1999 after the center dropped three children off at school -- the wrong school -- for summer session. The children walked 10 blocks to a Sav-A-Lot store to call a family friend, a trip that included crossing a busy street. The woman who drove them to school, it turned out, did not even have a valid driver's license, only a driver's permit. As part of the settlement agreement, Greater Dimension was allowed to keep operating, but the center agreed to record all transportation provided to children, to secure written authorization from each child's parent, to develop a written transportation plan and to make copies of the licenses of any workers who transport children. It was also placed under "close supervision" for six months, during which time inspectors could make unannounced visits at least once a month.

Often, there is a tremendous lag time between when a potentially dangerous incident occurs and when a settlement agreement is signed.

In December 1996, Estanya Collins of Kansas City admitted leaving a 4- year-old in her car outside a Wal-Mart while she shopped for Christmas presents. It was 8 degrees outside at the time. The state, however, did not learn of the incident until a child-abuse screening was conducted as part of her license renewal in October 1998. Her license to care for 10 children was renewed. As part of the settlement agreement, she agreed to undergo 12 hours of child-care training, to work under close supervision for 12 months, to keep a log anytime she transports a child and to bring an approved adult assistant along on trips. The agreement wasn't signed until March 1999.

Franklin, head of child-care regulation in Missouri, says that because the screenings are only done every two years as part of the licensing process, an incident that occurs shortly after a license renewal might not be brought to the state's attention until much, much later. In 1999, she adds, the state was changing its procedures in handling settlement agreements: "We were reframing how we were doing those, so that might speak to some of the lag time. We are trying to improve the lag time."

In the highly unlikely scenario (at least in Missouri) that a facility has its license revoked, it can still care for four unrelated children in a home; nothing in the laws prohibits a previously disciplined child-care provider from doing so as long as it does not receive state or federal subsidies.

As for workers, although the state is supposed to check its child-abuse-and-neglect registry, someone who was fired from a facility for hitting a child, for instance, may not show up in that registry. Before the state will issue substantiation of a finding of physical abuse, there must be a documentable injury, such as a bruise, bite mark or broken bone. Emotional abuse is even more difficult to substantiate, says Dewey Riehn, director of the out-of-home investigative unit of the Missouri Division of Family Services. If a worker is accused of locking a child in a darkened room, for instance, a professional must also attest that the incident triggered a specific behavior, such as a return to thumb-sucking in an older child.

And though criminal-background checks are required of workers at licensed or subsidized child-care facilities, even a jury's conviction doesn't necessarily put someone out of the child-care business.

Consider the case of Denise Williams of Kansas City. In September 1996, the state renewed her family-daycare-home license to care for up to 10 children. In July 1997, she was convicted of three counts of endangering the welfare of a child, a Class A misdemeanor. Her crime was leaving three children alone in a van in 90-degree weather. Security officers found the children "very hot, sweating heavily, and complaining of thirst." It was unclear how long they had been left in the van. Despite the conviction, Williams was allowed to continue operating her child-care home. In a settlement agreement signed in May 1999 -- almost two years after her conviction -- she agreed not to transport any children unless it was an emergency, and then only with an approved adult assistant. She agreed to undergo 12 hours of training, and her facility was placed on 12 months of close supervision.

State officials explained her case by noting that the judge placed Williams on two years' probation, then suspended imposition of the sentence. Franklin says that because of the suspended sentence, her office lacked legal grounds to revoke William's license: "That can't be my sole reason for taking their license or denying them a license.... We have to be very careful that we follow due process. We can't arbitrarily take action against a license."

Corinne Patton, coordinator of the public-awareness campaign for the Missouri Child Care Resource and Referral Network, defends the work of child-care inspectors. "Those folks take their jobs very seriously," she says. "I think when they find a rule violation, it is cited and people are expected to correct it. Some states don't do any visits unless there is a complaint. Missouri visits twice a year. I think they do make every effort to make sure people comply with the rules and, if there is a problem, work with someone to correct it. They bend over backward to give people a chance to correct a problem -- sometimes they bend too far -- but it is very hard to take someone's license away once it is granted."

She concedes that there is room for improvement: "There is a lot going on in child care right now; we are getting more attention than ever before. Some of that close scrutiny is going to point out what is not OK."

Ann Watts, director of community services at the Child Day Care Association in St. Louis, agrees: "We wish there were more licensing representatives, so their caseloads were small and they could visit more often. We wish more of the care was regulated. I think the regulatory system is built on giving people a chance to correct their problems. I think the public's concern is how long does the problem go on, how did it happen and how do we make sure it doesn't happen again. Overall," Watts adds, "we have lots of real mediocre care. We have good care, and we probably have some that is really bad. But there's lots of middle-of-the-road care."

Carol Metzenthin is a family day-care-home operator in Webster Groves who has been taking care of children for 17 years. She believes the state is already aggressive when it perceives a problem -- and that further regulation would only drive more and more people like her out of the business. She says increasing regulations and fears about liability have heaped an overwhelming amount of paperwork on providers like her. She is licensed to care for 10 children in her home.

Last year, she says, she asked for help from an inspector during a visit and described how she was handling a particularly difficult little boy. She was caring for a 3-year-old child who was distracted and nonverbal and who, in an instant, could climb out of his playpen and be out the door. For his own safety, she says, she put him in a playpen with a hinged piece of plywood clipped on top. It was the only way he would settle down for a nap, Metzenthin says. "I went with my gut instinct. It was appropriate for that child," she says. Much to her surprise, the state responded by initiating a complaint investigation against her. "I was asking them for help, for the betterment of that child," she says. "He could fly out of that playpen and in half-a-second be out the door." She stopped using the playpen. The child was later found to be autistic. Under her care, she adds, the boy made significant progress, speaking in sentences and learning to play much like other children.

She is adamant in her view that the state oversteps its bounds in regulating family-child-care homes like hers, where she strives for a homelike setting, not an institutional one. "This is not a perfect world," Metzenthin says. "Everything is so monitored right now. We could have cameras in all these daycares, and that would do it. The state could start requiring that all children wear helmets.... I think the state already does a lot. They are demanding more and more and more and more.... Maybe we should do away with daycare entirely. Then will we monitor these children's parents?"

Cande Iveson, senior policy analyst with Citizens for Missouri's Children, believes the state has made progress with its caregiver screening service on the Internet, legislation making it easier for the state to suspend licenses at facilities and the law requiring background checks of registered vendors. She doesn't see further regulation -- or tougher enforcement -- in Missouri's immediate future. Legislators won't allow it, she says.

When the state was considering the legislation that required criminal-background checks for registered vendors, there was vocal opposition, Iveson says: "I had parents saying, 'I don't care -- I would rather have my kids with someone I know rather than a stranger, even if that someone I know had a felony record of assault.'"

Iveson says there is a movement in Missouri toward better quality, though not increased regulation. If the quality was there, she says, tough enforcement wouldn't be necessary: "Parents have to say this is not acceptable. If they stopped buying the services, if they have enough other good choices they can afford, they wouldn't have to choose a provider that does that." But those choices don't exist for most parents. "If every parent understood what kinds of things they should be looking for in child care," Iveson says, "and if they had say two or three places that offered all those things, that were close to where they lived and worked, that they could afford, then you'd see real progress in the overall quality of care. But we are a long way from that."

Iveson predicts that any proposals for further regulations will meet with much resistance: "We have a huge reluctance here in Missouri to require any more regulation that we already do. 'It's the government interfering in our lives. It's Big Brother.' That was one of the arguments against the caregiver screenings. It's 'You're trying to regulate Grandma.' The reality is that some of the grandmas out there caring for kids are not really people you'd want."

And Missouri, as yet, hasn't experienced the sort of widely publicized child-care tragedies that occurred last summer in Tennessee, when the two children died on a single day, drawing intense attention and demands for change.